Monday, July 17, 2017

Tough Conversations  (Part 1: A Parent's Plan for Suicide Prevention)



This three-part series for parents deals with some of the toughest conversations that are becoming some of the most frequent conversations in many homes in America. With school just around the corner, it would be wise to make time to discuss these issues at home before they become issues outside the home.

Part 1 - A Parent's Plan for Suicide Prevention
Part 2 - Having the Sexuality Talk
Part 3 - Anti-bullying Tactics that work



The phone rings on a Wednesday afternoon, and a mom says, My son has been suspended from school, and before he can return, he has to have a counseling session. He said he was thinking about hurting himself. Can you see him today?


Too many times I have received this phone call from either a parent or a school administrator, and in every case, they are scared, confused, in panic mode, and in desperate need for immediate help.  Knowing how to respond in the first hour of this type of crisis will determine the tone that is set, as well as the help that is received. Every parent would do well to prepare for this kind of event.


This three-part series is being offered to help with some of the toughest conversations parents have to have with their kids. Many parents are dragged into difficult conversations, kicking and screaming. So many parents are overwhelmed with certain topics they are not prepared to deal with, much less work through.


If parents can avoid certain conversations, they do. But the fact is that children are dealing with certain realities in mass that parents only had to deal with in part when they were their children’s age. This first article in the series deals with the awkward and messy realities of talking to kids when we discover they are having thoughts of self-harm.



Often parents ask the question, “How do I even begin to talk about this?” In other words, there are so many questions, and not nearly enough answers, it is hard to know what a starting point looks like, much less forward motion.

Let me say at the outset here without being too transparent that my wife and I have personal experience here. We do not know what it is like to lose a child to suicide, and therefore I do not make claims here to that extent. I do know, however, what it is like to receive a phone call from a concerned party that one of my kids needs immediate help. So I have been that parent that had to assess in minutes what the next step will be in order to provide my child with the kind of help they needed.

My background as a mental health professional has also included working with children and adolescents for years in primary, secondary, and post-secondary educational settings. I have been the parent who needed help, the counselor who called the parents, as well as the administrator that had to set in motion a course of action within minutes in order to address a life and death situation. From these experiences, I would like to share some common denominators  I have learned that proved to be helpful in the short period of time that exists between finding out about the crisis and then offering support in the crisis.

As a starting point, here are some preliminary questions that all parents should ask prior to ever being confronted with such a situation:



1. Is the culture in my home such that my kid is willing to share sensitive information with me, or do other people have to bring it to my attention?

This question is not about passing judgment because there are several reasons why our kids may not choose to tell us some things, and instead share this private information with someone else they trust.

·        Perhaps they are no longer living in the home.

·        Perhaps they live in multiple locations (shared custody).

·        Perhaps there is division in the home.

·        Perhaps life is out of balance and opportunities to talk are illusive.

·        Perhaps they have tried to talk, but attempts have failed.

Again, not to cry over spilled milk, the point here is not to assign blame, but rather to call things what they are. If your kid is not comfortable talking with you about intense feelings in their life, there is a legitimate reason which needs to be addressed. The point of addressing this reality is not to dwell on it, but rather to use this information as a launching pad for growth and change in your home.


It may be time to:

·        Re-balance work/family life (hardly ever home)

·        Create spaces for honest conversation (meal times at the table)

·        Deal with division in the home (rather than run from it or ignore it)

·        Take some responsibility for current realities rather than scapegoating

A lot of time can be wasted assigning blame or reeling from the reality that our kids feel more comfortable talking to someone else rather than us. The positive side of this certainly could include that they talk to someone, rather than no one. So time here is better invested figuring out, before the next crisis, who are kids are talking to and why. Moving forward must begin with honesty about the culture of communication in the home. This is not time for a lecture, but a lesson in truth.



2. When my kids talk to me about sensitive issues, is the response supportive or punitive?

I cringe when parents make negative emotional connections to a positive event, and certainly our kids sharing intense emotions with us is a positive thing. So parents must be sure to ‘reward’ such courage with en-courage-ment. Bringing out these intense feelings should be the first order of business, not shutting them down because we forget to control our own emotions.  So the first response (not reaction) is crucial when our kids muster up the courage to tell us something they considered keeping to themselves:

“We are so glad you are talking with us about this.”

“This must be very difficult to talk about, but still you are making the effort.”

“I cannot imagine how long you held this in or how you did this alone.”

“As hard as this may be for us to hear, we will always be here to listen to you.”


The first response in a crisis will set the tone for how the conversation will go, but more importantly, whether or not you will get another one. 

The goal here is to not just keep them talking, but to entice them back for more support, more understanding, more love, more encouragement, more time with the very people that they are hoping will understand the most.


I emphasize that any form of punishment (tone, discipline, authoritarianism, body language, restrictions, mandated counseling) will have adverse effects and probably shut down the emotional outpouring. This tension is a hard balancing act because what may not seem to be a punishment can be perceived as such, so tread lightly and ask your child the obvious as you attempt to respond:

“Does this feel like punishment?”

If the answer is “yes,” then you have to fix that immediately so that the memory of this initial response is supportive, not something to be avoided in the future.

“Do you feel heard and understood?”

If the answer is “no”, then regroup, set aside preconceived notions, and seek to understand until the answer is “yes”.  Often the difference between understanding a teen or not is the assumption that they have something to teach you. The lesson is not always one parents prefer, but preference is not the goal of communication. The goal of communication is hearing, not being heard.

____________________________

The first two items will determine the answer to item #3. In other words, if our children know they can come to us and when they do, we will be supportive, it is less likely we will need the help of a professional. But when it comes to self-harm, it is not time to go home and have a family meeting to determine a course of action.

So let’s assume that a family is in need of professional help. Let’s now consider some pertinent information for those who need help at that level.

3. Do we need professional help?

Before we jump to conclusions, let us evaluate the risk factors based on what kids actually say.

Here are three considerations:

“My kid said they are thinking about hurting themselves.”


Although these are not necessarily on an ascending order of risk, this is usually the lowest risk scenario.  Thinking about doing something is the first step and it is a fortunate thing to intervene at this level if the opportunity is offered. The goal here is to find out as much information as possible about what thoughts they are having, which requires continuous communication.  The conversation must remain about what they are experiencing, not how the parent feels about what they are experiencing. As long as they feel heard, they will continue to talk and share what is really going on with them. This is exactly what a professional would do, but it is easier for a counselor than a parent to suspend their curiosities and emotions.

If you are the parent your child approaches in a crisis, this is a suggested first step. Opening the door and keeping communication open is the priority as well as the immediate need should you discover your child is in crisis.

“My kid has indicated they have a specific plan for hurting themselves.”


Put yourself in your kid’s shoes and try to imagine what they are feeling, and then consider the kinds of things you would want from a caregiver like time, understanding, attention, and practical help. Many parents realize at this level that they are not equipped to provide all these things. Practical help, for example, requires an objective viewpoint, and emotions can get in the way for parents. In many cases, parents carry around unresolved pain from their own childhood experiences, and these emotions are hard to sort out when your child is in crisis.

If you discover that your child has either parts of a plan, or even a full-scale plan to harm themselves, reaching out for professional help is not only a good idea, it may be the critical objective piece  that is needed in order to maximize the early hours of  your child’s crisis.

I have many personal stories to share here, but confidentiality prevents me from alluding to even parts of these stories since I am still actively acquainted with many of these families. But I will say that these stories share these things in common:

·        Reaching out for help lowers parental anxiety levels .

Our kids feed off of our energy in a crisis, and sometimes parents make the crisis worse by a gut reaction rather than a thoughtful response. Sometimes parents think they know the right thing to do, but their uncertainty creates anxiety, and our kids pick up on that. In a crisis, every parent could use the help of someone who affirms their thoughts and feelings on the matter. Being confident of forward motion is better than just random motion.

·        Building a team of helpers increases the child’s confidence levels.

As long as that team is working together, our children benefit from knowing that a “wall of defense” is being built to protect them and guide them in a healthy direction. The selection of that team must be immediate, but collaborative. In other words, time is of the essence, but parents must allow their child to have a voice in who is given permission to help them. Ultimately, they have to sign off on anyone and everyone on this team, giving them purpose and hope that help is on the way, as well as the self-empowerment that may be sorely lacking in their life.

·        Having a “second opinion” on matters of self-harm is a good thing.

If a life-threatening illness or disease became a medical reality for one of our kids, we would likely seek a second opinion. So when a mental illness threatens our family, why would we not reach out for an outside perspective, just to make sure we know exactly what we are dealing with when it comes to the threat of suicide? Extremes of “no big deal” versus 'pushing the panic button' are to be avoided, and so bringing in help in the early hours is always a good call.

One last level to consider here…

“My kid indicated they have tried to hurt themselves and failed.”


Count your blessings you have this information, but without diminishing the seriousness of this dilemma, the reality is that most suicide attempts fail on the first try. With this information, however, parents have a 2nd chance to address the underlying reasons for their child’s hopelessness, alienation, or fears. Again, at this level, professional help should be sought immediately with the goal of opening up doors of communication at home. This is not the time for “I told you so” or “What were you thinking?” The most helpful attitude is “whatever it takes”, communicating that their cry for help has been duly heard.

So, to answer the question about professional help, it often depends upon parental anxiety levels and previously established doors of communication. It is likely that this article is being considered, not in a crisis situation, but perhaps in consideration of this untimely event occurring in the family. Perhaps you have already been down this road, and you are curious if you “did the right thing.” I work with a lot of adolescents, and sometimes with smaller children who are flirting with the edge of hopelessness. Getting help is a phone away and efforts here need not wait until a crisis occurs.



Hotlines

We all know that 911 is an option in every emergency, that the suicide crisis hotline (1-800-273-8255) should be on every parent's radar, and that there are resources in every community to help if our kids are in need of mental or emotional assistance. But what many parents do not know is what to do after the initial call for help is made. Having personal experience with the days, weeks, and months following such a need, let me close with some directional thoughts:

1. There is no such thing as an inconvenience when it comes to saving the lives of our children.

2. An investment in our children’s welfare and mental health is an investment in their future.

3. The follow through in a crisis is as important as responding to the initial crisis.

So before this need occurs, and before this next school year is in session, sit down as a family and have a tough conversation. Chances are, if they have been in a crisis of this nature before, they have already talked to someone else. My contention is that parents should be the first consideration, not the last. So open the doors of communication and let tough conversations be ones you are glad you had proactively. If you do, there will be many more.
(Next week: Having the Sexuality Talk)



© 2017 by Tim Bolen, LPC

Tim has a private practice serving two locations in Covington, GA and Loganville, GA, and works with adolescents and adults in crisis. You may contact him or set up an appointment by visiting his Psychology Today profile. Tim specializes in marriage and family issues as well as offering various groups and workshops in the Newton County area. You can also visit his website for additional resources at TriCord Hope.